Role of Ultrasound In The Diagnosis of Primary And Recurrent Dermatofibrosarcoma Protuberans

Abstract

Background: Dermatofibrosarcoma protuberans (DFSP) is a rare, low- to intermediate-grade sarcoma, which represents a diagnostic imaging challenge. This study aimed to analyze the clinical and ultrasound features of primary and recurrent DFSP to improve the diagnosis.Methods: Clinical, imaging, and pathological data from a total of 58 patients (23 patients with primary DFSP and 35 patients with recurrent DFSP) were retrospectively reviewed.Results: There was no statistically significant difference in age, sex, tumor size, or echogenicity between the two groups. Most of the primary DFSP lesions involved the overlying dermis and hypodermis, while most of the recurrent DFSP lesions were fixated to more deeply seated structures at the original surgical incision. Red nodules on the skin were found more frequently in the primary group. There were statistically significant differences in the type of lesion and ultrasound tumor morphology (p < 0.050). The lesions in the primary group showed more tentacle-like projections or a “claw” sign, while the lesions in the recurrent group were more commonly oval, lobulated, and irregularly shaped. Hypervascularity was common in both groups.Conclusions: For primary DFSP, a slow-growing, red nodule on the skin involving the overlying dermis and hypodermis, more frequently a hypoechoic mass with tentacle-like projections or a “claw” sign, was observed. For recurrent DFSP, palpable subcutaneous nodules or subcutaneous masses at the original surgical incision and oval, lobulated, and irregularly shaped lesions were more commonly observed. This may be useful for improving diagnostic accuracy.

Breast Imaging Findings in Dermatofibrosarcoma Protuberans: A Case Report and Review of Literature

“…Posterior acoustic enhancement is common due to the dense cellularity of the mass. Color Doppler evaluation often reveals intralesional hypervascularity, typically more peripheral than central [13]. Although our patient did not undergo further imaging studies to evaluate her breast lesion, previous studies have described the appearance of DFSP in the breast on other imaging modalities such as magnetic resonance imaging (MRI) and positron emission tomography-CT (PET-CT).…”